This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Effect of specialist decision‐making on treatment strategies for colorectal liver metastases. BJS 2012; 99: 1263-1269.
Published: 2nd August 2012
Authors: R. P. Jones, J.‐N. Vauthey, R. Adam, M. Rees, D. Berry, R. Jackson et al.
Background
One hundred and ten patients were treated with palliative chemotherapy, of whom 53 had liver‐only disease and had not been reviewed by a specialist liver surgeon. One scan was excluded as all reviewers felt it to be of insufficient quality to assess. Improved surgical technique and better chemotherapeutic manipulation of metastatic disease has increased the number of patients eligible for potentially curative resection of colorectal liver metastases. The rapid evolution in this field suggests that non‐specialist decision‐making may lead to inappropriate management. This study aimed to assess the management of colorectal liver metastases by non‐liver surgeons.
Method
All patients who underwent chemotherapy with palliative intent for metastatic colorectal cancer at a regional oncology centre between 1 January and 31 December 2009 were identified from a prospectively maintained local database. Six resectional liver surgeons blinded to patient management and outcome reviewed pretreatment imaging and assigned each scan a score based on their own management choice. A consensus decision was reached on the appropriateness of palliative chemotherapy.
Results
Tumours in 33 patients (63 per cent) were considered potentially resectable, with a high level of interobserver agreement (κ = 0·577). When individual approach to management was considered, interobserver agreement was less marked (κ = 0·378).
Conclusion
Management of patients with colorectal liver metastases without the involvement of a specialist liver multidisciplinary team can lead to patients being denied potentially curative treatments. Management of these patients must involve a specialist liver surgeon to ensure appropriate management. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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